脑梗死后抑郁患者杏仁核及其亚区的功能连接研究
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摘要
目的利用功能性磁共振成像技术(f MRI),研究与分析脑梗死后抑郁(PSD)患者静息态下杏仁核以及其各亚区与其他脑区功能连接的改变,以期为PSD的早期诊断及临床治疗提供帮助。方法对18例PSD患者及19例脑梗死后无抑郁患者(对照组)进行静息态f MRI扫描,以杏仁核自身及其3个亚区(两侧基底外侧核、两侧浅表核及两侧中央内侧核)为种子点,分别进行静息态脑功能连接(FC值)分析。研究两组患者种子点FC值结果的差异,并对PSD组汉密尔顿抑郁量表(HAMD)得分与差异脑区FC值进行Spearman相关性分析。结果与对照组相比,PSD组患者功能连接增强脑区为左侧中央内侧核-右侧额中回。其它观测部位均发生功能连接减低。PSD组左侧中央内侧核与右侧岛叶和前额叶,右侧基底外侧核与左侧楔前叶、左侧额上回,右侧浅表核与补充运动区,左侧杏仁核与下丘脑,右侧杏仁核与双侧楔前叶的功能连接与HAMD评分呈负相关,差异均有统计学意义(r=-0.674～-0.444,均P<0.05)。PSD组患者左侧中央内侧核与右侧额中回的功能连接与HAMD评分呈正相关,差异有统计学意义(r=0.546,P<0.05)。结论杏仁核可参与情绪控制与加工,PSD患者的杏仁核自身及其各亚区与多个脑区FC值存在异常,这些改变可能在抑郁产生的机制中发挥了重要作用。
Objective To analysis the functional connectivity changes of amygdala and its sub-regions with other brain regions in patients with post-stroke depression(PSD) by using resting-state functional magnetic resonance imaging(fMRI). Methods Eighteen patients with PSD and 19 cerebral infarction patients without PSD(control group) were recruited in the study. The functional connectivity(FC) method was used to select the amygdaloid nucleus and its three subpubs(both sides of laterobasal,centromedial and superficial)as the seed point, and the functional connectivity of amygdala and its sub-regions was analyzed. The difference between magnetic resonance data and the correlation with the HAMD score were analyzed by software SPSS 21.0. Results Compared with the control group, the connectivity of PSD was increased in brain regions including right middle frontal gyrus. Decreased functional connectivity occurred in all other observation sites. In PSD group, the functional connections between left medial central nucleus and right insular lobe and prefrontal lobe, right lateral basal nucleus and left anterior cuneiform lobe, left superior frontal gyrus, right superficial nucleus and complementary motor area, left amygdala and hypothalamus, right amygdala and bilateral anterior cuneiform lobe were negatively correlated with HAMD scores, and the differences were statistically significant(r=-0.674 ～-0.444, P<0.05). The functional connection between the left medial central nucleus and the right middle frontal gyrus was positively correlated with the HAMD score in the patients with PSD(r=0.546, P< 0.05). Conclusion Amygdala participates in processing emotion. Abnormal functional connectivity are demonstrated in amygdala and its subregions in PSD patients, which may play an important role in the mechanism of depression.
Objective To analysis the functional connectivity changes of amygdala and its sub-regions with other brain regions in patients with post-stroke depression(PSD) by using resting-state functional magnetic resonance imaging(fMRI). Methods Eighteen patients with PSD and 19 cerebral infarction patients without PSD(control group) were recruited in the study. The functional connectivity(FC) method was used to select the amygdaloid nucleus and its three subpubs(both sides of laterobasal,centromedial and superficial)as the seed point, and the functional connectivity of amygdala and its sub-regions was analyzed. The difference between magnetic resonance data and the correlation with the HAMD score were analyzed by software SPSS 21.0. Results Compared with the control group, the connectivity of PSD was increased in brain regions including right middle frontal gyrus. Decreased functional connectivity occurred in all other observation sites. In PSD group, the functional connections between left medial central nucleus and right insular lobe and prefrontal lobe, right lateral basal nucleus and left anterior cuneiform lobe, left superior frontal gyrus, right superficial nucleus and complementary motor area, left amygdala and hypothalamus, right amygdala and bilateral anterior cuneiform lobe were negatively correlated with HAMD scores, and the differences were statistically significant(r=-0.674 ～-0.444, P<0.05). The functional connection between the left medial central nucleus and the right middle frontal gyrus was positively correlated with the HAMD score in the patients with PSD(r=0.546, P< 0.05). Conclusion Amygdala participates in processing emotion. Abnormal functional connectivity are demonstrated in amygdala and its subregions in PSD patients, which may play an important role in the mechanism of depression.
引文
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[12]程健,吴文.额叶梗死卒中后抑郁患者静息态功能MRI的局部一致性研究[J].中华神经医学杂志,2017,16(11):1107-1111.DOI:10.3760/cma.j.issn.1671-8925.2017.11.005.
[2]Dijkhuizen RM,Kajo VDM,Otte WM,et al.Functional MRI and Diffusion Tensor Imaging of Brain Reorganization After Experimental Stroke[J].Translational Stroke Research,2012,3(1):36-43.DOI:10.1007/s12975-011-0143-8.
[3]Stalder-Lüthy F,Messerli-Burgy N,Hofer H,et al.Effect of Psychological Interventions on Depressive Symptoms in Long-Term Rehabilitation After an Acquired Brain Injury:a systematic review and meta-analysis[J].Archi Phys Med Rehabil,2013,94(7):1386-1397.DOI:10.1016/j.apmr.2013.02.013.
[4]Dwyer HK.Screening,diagnosis,and treatment of post-stroke depression[J].Journal of Neuroscience Nursing,2014,46(3):135-141.DOI:10.1097/JNN.0000000000000047.
[5]Li W,Ward BD,Xie C,et al.Amygdala network dysfunction in late-life depression phenotypes:Relationships with symptom dimensions[J].Journal of Psychiatric Research,2015,70:121-129.DOI:10.1016/j.jpsychires.2015.09.002.
[6]Amunts K,Kedo O,Kindler M,et al.Cytoarchitectonic mapping of the human amygdala,hippocampal region and entorhinal cortex:intersubject variability and probability maps[J].Anatomy&Embryology,2005,210(5-6):343-352.DOI:10.1007/s00429-005-0025-5.
[7]Sun N,Li QJ,Lv DM,et al.A survey on 465 patients with post-stroke depression in China[J].Archives of Psychiatric Nursing,2014,28(6):368-371.DOI:10.1016/j.apnu.2014.08.007.
[8]Egorova N,Veldsman M,Cumming T,et al.Fractional amplitude of low-frequency fluctuations(f ALFF)in poststroke depression[J].NeuroImage Clin,2017,16,116-124.DOI:10.1016/j.nicl.2017.07.014.
[9]王恩锋,刘立亚,张红菊,等.伴有抑郁症状原发性失眠患者静息态磁共振脑默认网络评价[J].中华神经科杂志,2015,48(11):1000-1006.DOI:10.3760/cma.j.issn.1006-7876.2015.11.014.
[10]Liu H,Tang Y,Womer F,et al.Differentiating Patterns of Amygdala-Frontal Functional Connectivity in Schizophrenia and Bipolar Disorder[J].Schizophrenia Bulletin,2014,40(2):469-477.DOI:10.1093/schbul/sbt044.
[11]Liu Z,Xu C,Xu Y,et al.Decreased regional homogeneity in insula and cerebellum:a resting-state f MRI study in patients with major depression and subjects at high risk for major depression[J].Psychiatry Research Neuroimaging,2010,182(3):211-215.DOI:10.1016/j.pscychresns.2010.03.004.
[12]程健,吴文.额叶梗死卒中后抑郁患者静息态功能MRI的局部一致性研究[J].中华神经医学杂志,2017,16(11):1107-1111.DOI:10.3760/cma.j.issn.1671-8925.2017.11.005.